202 Which Anticholinergic Drug for Adults With

Total Page:16

File Type:pdf, Size:1020Kb

202 Which Anticholinergic Drug for Adults With 202 Madhuvrata P1, Singh M2, Abdel-Fattah M3 1. Sheffield Teaching Hospital,UK, 2. Sheffield Teaching Hospital, UK, 3. University of Aberdeen, UK WHICH ANTICHOLINERGIC DRUG FOR ADULTS WITH NEUROGENIC DETRUSOR OVERACTIVITY? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED TRIALS Hypothesis / aims of study We aim to compare the efficacy, tolerability and safety of one anticholinergic drug versus another and also higher doses of anticholinergics versus lower dose in the treatment of adult neurogenic detrusor overactivity (NDO). Study design, materials and methods : Literature search of MEDLINE, EMBASE, Cochrane incontinence specialised trials register, clinicaltrials.gov and IUGA/ICS conference abstract databases was performed from 1966 to January 2011. Randomised trials (RTs) comparing one anticholinergic drug with other or two doses of the same anticholinergic drug, in adults with NDO were included. Trials comparing anticholinergics versus placebo were excluded. Data were extracted independently by two authors. Data was analysed using Rev-Man 5. The primary outcome was the clinical cure/ improvement; both patient-reported cure and objective cure. The secondary outcomes were quality of life (Qol), Overactive bladder symptoms (urinary frequency/24hrs, urgency/24hrs, incontinence/24hrs), Urodynamic outcomes (maximum cystometric capacity, maximum detrusor contraction, number of detrusor contractions, residual volume), adverse events (dry mouth) and withdrawals due to adverse events. Fig1: Oxybutynin vs other AC- Change in frequency/24hrs and change in incontinence/24hrs Other drug Oxybutynin Mean Difference Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI 5.3.1 Change in frequency/24hr Fader 2007 -1.6 2 57 -1.2 1.8 57 38.2% -0.40 [-1.10, 0.30] Gajewski 1986 -0.6 0.8 11 -1.3 0.8 15 43.2% 0.70 [0.08, 1.32] Stohrer 2007 -2.9 2.9 54 -2.5 3.3 52 18.6% -0.40 [-1.58, 0.78] Subtotal (95% CI) 122 124 100.0% 0.03 [-0.78, 0.84] Heterogeneity: Tau² = 0.34; Chi² = 6.20, df = 2 (P = 0.04); I² = 68% Test for overall effect: Z = 0.07 (P = 0.95) 5.3.2 Change in incontinence/24hrs Fader 2007 -0.9 1.7 57 -0.9 1.6 57 37.2% 0.00 [-0.61, 0.61] Gajewski 1986 -0.5 0.8 11 -1 0.8 15 36.3% 0.50 [-0.12, 1.12] Stohrer 2007 -1.6 2.3 54 -1.3 2 52 26.5% -0.30 [-1.12, 0.52] Subtotal (95% CI) 122 124 100.0% 0.11 [-0.33, 0.55] Heterogeneity: Tau² = 0.03; Chi² = 2.59, df = 2 (P = 0.27); I² = 23% Test for overall effect: Z = 0.51 (P = 0.61) -10 -5 0 5 10 Favours other drug Favours oxybutynin Fig 2: Oxybutynin versus other AC- Urodynamic parameters Other drug Oxybutynin Mean Difference Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI 5.2.1 Maximum cystometric capacity Gajewski 1986 198 129 6 282.5 117.9 12 19.4% -84.50 [-207.40, 38.40] Stohrer 2007 309 166 46 298 125 45 80.6% 11.00 [-49.29, 71.29] Subtotal (95% CI) 52 57 100.0% -21.12 [-109.55, 67.31] Heterogeneity: Tau² = 2121.06; Chi² = 1.87, df = 1 (P = 0.17); I² = 47% Test for overall effect: Z = 0.47 (P = 0.64) 5.2.2 Maximum detrusor contraction Gajewski 1986 44.7 33 6 36.7 24 12 14.7% 8.00 [-21.69, 37.69] Stohrer 2007 38 31 46 43 29 45 85.3% -5.00 [-17.33, 7.33] Subtotal (95% CI) 52 57 100.0% -3.09 [-14.48, 8.30] Heterogeneity: Tau² = 0.00; Chi² = 0.63, df = 1 (P = 0.43); I² = 0% Test for overall effect: Z = 0.53 (P = 0.60) -200 -100 0 100 200 Favours oxybutynin Favours other drug Results 11RTs with 767 men and womenincluded; 7 RTs comparing oral Oxybutynin to other anticholinergics, 2 RTs comparing different doses of same anticholinergic (trospium and tolterodine) and one trial comparing extended versus immediate release propiverine. A further trial compared methantheline, flavoxate and meladrazine, but reported no usable data for this meta- analysis. - Oxybutynin versus other anticholinergic :7 RTs compared oxybutynin versus other anticholinergic drugs (propantheline, trospium, propiverine, intravesical atropine, intravesical oxybutynin and controlled release oxybutynin). Treatment duration ranged from 3 to 8 weeks. Meta-analyses showed better cure/improvement (Risk Ratio (RR) 0.80, 95% CI 0.52, 1.24) with oxybutynin when compared to other anticholinergics but not statistically significant. There was no difference in the mean change of frequency/24hr (Fig 1) (Weighted Mean Difference (WMD) 0.03, 95% CI -0.78, 0.84), mean change of incontinence/24hrs (WMD 0.11, 95% CI - 0.33, 0.55) (Fig 1), maximum cystometric capacity (Fig 2) (WMD -21.12, 95%CI -109.55, 67.31) and maximum detrusor contraction (WMD -3.09, 95% CI -14.48, 8.30) (Fig 2) at end of treatment between the groups. The dry mouth rate was higher in the oxybutynin group although not significant (RR 0.71, 95% CI 0.41, 1.21) and the withdrawals due to adverse events (RR 1.07, 95% CI 0.36, 3.17) were comparable. Only one study assessed Qol, but the data was not in usable form. - Different doses of Tolterodine: Only one RT compared different doses of tolterodine (0.5mg vs 1mg vs 2mg vs 4mg) Outcomes were assessed at 2 weeks; the maximum cystometric capacity improved with increasing dose although not statistically significant. Dry mouth was reported to be increased with increasing dose of tolterodine but not significantly different between the different doses of tolterodine. - Different dosing regimen of Trospium: One trial (Menarini 2006) reported different dosing regimens of trospium, comparing fixed dose (45mg/day) versus adjustable dose (permissible to increase dose to 90 or 135mg/day). Urodynamic outcomes were assessed: here was no significant difference in the change in maximum cystometric capacity (WMD -45.0, 95%CI -110.6, 20.6) or change in detrusor pressure (WMD 13, 95% CI -0.58, 26.6). There was no significant difference incompliance (WMD 8.0, 95% CI -34.41, 50.41) or incidence of dry mouth (RR 0.81, 95% CI 0.45, 1.46). - Extended release versus immediate release Propiverine: One RT (Stohrer 2009) compared immediate release with extended release propiverine and the outcomes were assessed at 3 weeks. Data was not in usable form for this review. Dry mouth was not different between the two groups. Interpretation of results This meta-analysis shows a trend towards higher cure /improvement rates however also higher rates of dry mouth with oxybutynin when compared to other anticholinergic drugs, both of which were not statistically significant. Similarly, there was no evidence of significant differences in urinary symptoms or urodynamic parameters at end of treatment between both groups. Only one RT comparing different doses of tolterodine, trospium chloride and extended versus immediate release propiverine were identified, therefore meta-analysis of these comparisons was not possible. This evidence is limited by heterogeneity of outcome measures, short-term follow up and relatively high risk of bias in some RTs. None of the RTs compared the newer antimuscarinic drugs such as Solifenacin, Fesoteridine, Darifenacin, and others. Concluding message In patients with NDO, there is no convincing evidence of better cure/ improvement in OAB symptoms with oxybutynin over other antimuscarinic drugs. High quality studies with longer follow-up incorporating standardised outcome measures and quality of life assessment are required. Efficacy and safety of newer anticholinergics should be evaluated in NDO. Specify source of funding or grant None Is this a clinical trial? No What were the subjects in the study? NONE .
Recommended publications
  • The National Drugs List
    ^ ^ ^ ^ ^[ ^ The National Drugs List Of Syrian Arab Republic Sexth Edition 2006 ! " # "$ % &'() " # * +$, -. / & 0 /+12 3 4" 5 "$ . "$ 67"5,) 0 " /! !2 4? @ % 88 9 3: " # "$ ;+<=2 – G# H H2 I) – 6( – 65 : A B C "5 : , D )* . J!* HK"3 H"$ T ) 4 B K<) +$ LMA N O 3 4P<B &Q / RS ) H< C4VH /430 / 1988 V W* < C A GQ ") 4V / 1000 / C4VH /820 / 2001 V XX K<# C ,V /500 / 1992 V "!X V /946 / 2004 V Z < C V /914 / 2003 V ) < ] +$, [2 / ,) @# @ S%Q2 J"= [ &<\ @ +$ LMA 1 O \ . S X '( ^ & M_ `AB @ &' 3 4" + @ V= 4 )\ " : N " # "$ 6 ) G" 3Q + a C G /<"B d3: C K7 e , fM 4 Q b"$ " < $\ c"7: 5) G . HHH3Q J # Hg ' V"h 6< G* H5 !" # $%" & $' ,* ( )* + 2 ا اوا ادو +% 5 j 2 i1 6 B J' 6<X " 6"[ i2 "$ "< * i3 10 6 i4 11 6! ^ i5 13 6<X "!# * i6 15 7 G!, 6 - k 24"$d dl ?K V *4V h 63[46 ' i8 19 Adl 20 "( 2 i9 20 G Q) 6 i10 20 a 6 m[, 6 i11 21 ?K V $n i12 21 "% * i13 23 b+ 6 i14 23 oe C * i15 24 !, 2 6\ i16 25 C V pq * i17 26 ( S 6) 1, ++ &"r i19 3 +% 27 G 6 ""% i19 28 ^ Ks 2 i20 31 % Ks 2 i21 32 s * i22 35 " " * i23 37 "$ * i24 38 6" i25 39 V t h Gu* v!* 2 i26 39 ( 2 i27 40 B w< Ks 2 i28 40 d C &"r i29 42 "' 6 i30 42 " * i31 42 ":< * i32 5 ./ 0" -33 4 : ANAESTHETICS $ 1 2 -1 :GENERAL ANAESTHETICS AND OXYGEN 4 $1 2 2- ATRACURIUM BESYLATE DROPERIDOL ETHER FENTANYL HALOTHANE ISOFLURANE KETAMINE HCL NITROUS OXIDE OXYGEN PROPOFOL REMIFENTANIL SEVOFLURANE SUFENTANIL THIOPENTAL :LOCAL ANAESTHETICS !67$1 2 -5 AMYLEINE HCL=AMYLOCAINE ARTICAINE BENZOCAINE BUPIVACAINE CINCHOCAINE LIDOCAINE MEPIVACAINE OXETHAZAINE PRAMOXINE PRILOCAINE PREOPERATIVE MEDICATION & SEDATION FOR 9*: ;< " 2 -8 : : SHORT -TERM PROCEDURES ATROPINE DIAZEPAM INJ.
    [Show full text]
  • The Effects of Oral Administration of the Novel Muscarinic Receptor
    Choi et al. BMC Urology (2020) 20:41 https://doi.org/10.1186/s12894-020-00611-8 RESEARCH ARTICLE Open Access The effects of oral administration of the novel muscarinic receptor antagonist DA- 8010 on overactive bladder in rat with bladder outlet obstruction Jin Bong Choi1, Seung Hwan Jeon2, Eun Bi Kwon3, Woong Jin Bae4, Hyuk Jin Cho2, U-Syn Ha2, Sung-Hoo Hong2, Ji Youl Lee2 and Sae Woong Kim4* Abstract Background: DA-8010 is a novel compound developed for the treatment of overactive bladder (OAB) and urinary incontinence. The aims of this study were to investigate the effects of DA-8010 on OAB in a rat model. Methods: Study animals were divided into the following five groups of seven animals each: a sham-operated control group, a control group with partial bladder outlet obstruction (BOO) (OAB group), and three DA-8010 (doses of 0.3 mg/kg/day, 1 mg/kg/day, and 3 mg/kg/day, respectively) with partial BOO groups. Oral administration of the drugs was continued for 14 days after 2 weeks of partial BOO. After 4 weeks of partial BOO, cystometrography was performed in all groups. Additionally, pro-inflammatory cytokines, Rho-kinases, and histology of the bladder were analyzed. Results: There was a significant increase in the contraction interval and a decrease in contraction pressure in the 3 mg/kg/day DA-8010 group versus those in the OAB group. Rho kinase was also significantly decreased in the DA- 8010 3 mg/kg/day dosage treatment group. The increased ratio of collagen to smooth muscle after partial BOO was significantly attenuated in the DA-8010 3 mg/kg/day dosage group.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 De Juan Et Al
    US 200601 10428A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2006/0110428A1 de Juan et al. (43) Pub. Date: May 25, 2006 (54) METHODS AND DEVICES FOR THE Publication Classification TREATMENT OF OCULAR CONDITIONS (51) Int. Cl. (76) Inventors: Eugene de Juan, LaCanada, CA (US); A6F 2/00 (2006.01) Signe E. Varner, Los Angeles, CA (52) U.S. Cl. .............................................................. 424/427 (US); Laurie R. Lawin, New Brighton, MN (US) (57) ABSTRACT Correspondence Address: Featured is a method for instilling one or more bioactive SCOTT PRIBNOW agents into ocular tissue within an eye of a patient for the Kagan Binder, PLLC treatment of an ocular condition, the method comprising Suite 200 concurrently using at least two of the following bioactive 221 Main Street North agent delivery methods (A)-(C): Stillwater, MN 55082 (US) (A) implanting a Sustained release delivery device com (21) Appl. No.: 11/175,850 prising one or more bioactive agents in a posterior region of the eye so that it delivers the one or more (22) Filed: Jul. 5, 2005 bioactive agents into the vitreous humor of the eye; (B) instilling (e.g., injecting or implanting) one or more Related U.S. Application Data bioactive agents Subretinally; and (60) Provisional application No. 60/585,236, filed on Jul. (C) instilling (e.g., injecting or delivering by ocular ion 2, 2004. Provisional application No. 60/669,701, filed tophoresis) one or more bioactive agents into the Vit on Apr. 8, 2005. reous humor of the eye. Patent Application Publication May 25, 2006 Sheet 1 of 22 US 2006/0110428A1 R 2 2 C.6 Fig.
    [Show full text]
  • Anticholinergic Drugs Improve Symptoms but Increase Dry Mouth in Adults with Overactive Bladder Syndrome
    Source of funding: Evid Based Nurs: first published as 10.1136/ebn.6.2.49 on 1 April 2003. Downloaded from Review: anticholinergic drugs improve symptoms but Health Research Council of Aotearoa increase dry mouth in adults with overactive bladder New Zealand. syndrome For correspondence: Jean Hay-Smith, Hay-Smith J, Herbison P,Ellis G, et al. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Dunedin School of Cochrane Database Syst Rev 2002;(3):CD003781 (latest version May 29 2002). Medicine, University of Otago, Dunedin, New QUESTION: What are the effects of anticholinergic drugs in adults with overactive Zealand. jean.hay-smith@ bladder syndrome? otago.ac.nz Data sources Parallel arm studies of anticholinergic drugs v placebo for overactive bladder syndrome in Studies were identified by searching the Cochrane adults at 12 days to 12 weeks* Incontinence Group trials register (to January 2002) Weighted event rates and reference lists of relevant papers. Anticholinergic Study selection Outcomes drugs Placebo RBI (95% CI) NNT (CI) Randomised or quasi-randomised controlled trials in Self reported cure or adults with symptomatic diagnosis of overactive bladder improvement (8 studies) 63% 45% 41% (29 to 54) 6 (5 to 8) syndrome, urodynamic diagnosis of detrusor overactiv- RRI (CI) NNH (CI) ity, or both, that compared an anticholinergic drug Dry mouth (20 studies) 36% 15% 138 (70 to 232) 5 (4 to 7) (given to decrease symptoms of overactive bladder) with Outcomes Weighted mean difference (CI) placebo or no treatment. Studies of darifenacin, emepronium bromide or carrageenate, dicyclomine Number of leakage episodes in 24 hours (9 − chloride, oxybutynin chloride, propiverine, propanthe- studies) 0.56 (–0.73 to –0.39) Number of micturitions in 24 hours (8 studies) −0.59 (–0.83 to –0.36) line bromide, tolterodine, and trospium chloride were Maximum cystometric volume (ml) (12 studies) 54.3 (43.0 to 65.7) included.
    [Show full text]
  • Package Leaflet
    Version 4, 02/2016 Propigen 5 mg coated tablets v005common PACKAGE LEAFLET 1 PACKAGE LEAFLET: INFORMATION FOR THE USER PROPIGEN 5 MG COATED TABLETS (PROPIVERINE HYDROCHLORIDE) Read all of this leaflet carefully before you or your child start taking this medicine because it contains important information for you. - Keep this leaflet. You may need to read it again. - If you have any further questions, ask your doctor or your pharmacist. - This medicine has been prescribed for you or your child, respectively, only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours or your child’s. - If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet (see section 4). The name of your medicine is Propigen 5 mg. The active substance is propiverine hydrochloride and the other ingredients are listed at the end of the leaflet (section 6, Contents of the pack and other information). What is in this leaflet: 1. What Propigen 5 mg is and what it is used for 2. What you need to know before you or your child take Propigen 5 mg 3. How to take Propigen 5 mg 4. Possible side effects 5. How to store Propigen 5 mg 6. Contents of the pack and other information 1. WHAT PROPIGEN 5 MG IS AND WHAT IT IS USED FOR Propigen 5 mg is used for the treatment of adults and children who have difficulty in controlling their bladder due to bladder overactivity or, in some cases, problems with the spinal cord.
    [Show full text]
  • Pharmaceutical Appendix to the Tariff Schedule 2
    Harmonized Tariff Schedule of the United States (2007) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2007) (Rev. 2) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. ABACAVIR 136470-78-5 ACIDUM LIDADRONICUM 63132-38-7 ABAFUNGIN 129639-79-8 ACIDUM SALCAPROZICUM 183990-46-7 ABAMECTIN 65195-55-3 ACIDUM SALCLOBUZICUM 387825-03-8 ABANOQUIL 90402-40-7 ACIFRAN 72420-38-3 ABAPERIDONUM 183849-43-6 ACIPIMOX 51037-30-0 ABARELIX 183552-38-7 ACITAZANOLAST 114607-46-4 ABATACEPTUM 332348-12-6 ACITEMATE 101197-99-3 ABCIXIMAB 143653-53-6 ACITRETIN 55079-83-9 ABECARNIL 111841-85-1 ACIVICIN 42228-92-2 ABETIMUSUM 167362-48-3 ACLANTATE 39633-62-0 ABIRATERONE 154229-19-3 ACLARUBICIN 57576-44-0 ABITESARTAN 137882-98-5 ACLATONIUM NAPADISILATE 55077-30-0 ABLUKAST 96566-25-5 ACODAZOLE 79152-85-5 ABRINEURINUM 178535-93-8 ACOLBIFENUM 182167-02-8 ABUNIDAZOLE 91017-58-2 ACONIAZIDE 13410-86-1 ACADESINE 2627-69-2 ACOTIAMIDUM 185106-16-5 ACAMPROSATE 77337-76-9
    [Show full text]
  • Marrakesh Agreement Establishing the World Trade Organization
    No. 31874 Multilateral Marrakesh Agreement establishing the World Trade Organ ization (with final act, annexes and protocol). Concluded at Marrakesh on 15 April 1994 Authentic texts: English, French and Spanish. Registered by the Director-General of the World Trade Organization, acting on behalf of the Parties, on 1 June 1995. Multilat ral Accord de Marrakech instituant l©Organisation mondiale du commerce (avec acte final, annexes et protocole). Conclu Marrakech le 15 avril 1994 Textes authentiques : anglais, français et espagnol. Enregistré par le Directeur général de l'Organisation mondiale du com merce, agissant au nom des Parties, le 1er juin 1995. Vol. 1867, 1-31874 4_________United Nations — Treaty Series • Nations Unies — Recueil des Traités 1995 Table of contents Table des matières Indice [Volume 1867] FINAL ACT EMBODYING THE RESULTS OF THE URUGUAY ROUND OF MULTILATERAL TRADE NEGOTIATIONS ACTE FINAL REPRENANT LES RESULTATS DES NEGOCIATIONS COMMERCIALES MULTILATERALES DU CYCLE D©URUGUAY ACTA FINAL EN QUE SE INCORPOR N LOS RESULTADOS DE LA RONDA URUGUAY DE NEGOCIACIONES COMERCIALES MULTILATERALES SIGNATURES - SIGNATURES - FIRMAS MINISTERIAL DECISIONS, DECLARATIONS AND UNDERSTANDING DECISIONS, DECLARATIONS ET MEMORANDUM D©ACCORD MINISTERIELS DECISIONES, DECLARACIONES Y ENTEND MIENTO MINISTERIALES MARRAKESH AGREEMENT ESTABLISHING THE WORLD TRADE ORGANIZATION ACCORD DE MARRAKECH INSTITUANT L©ORGANISATION MONDIALE DU COMMERCE ACUERDO DE MARRAKECH POR EL QUE SE ESTABLECE LA ORGANIZACI N MUND1AL DEL COMERCIO ANNEX 1 ANNEXE 1 ANEXO 1 ANNEX
    [Show full text]
  • Comparision Effects of Solifenacin, Darifenacin, Propiverine on Ocular Parameters in Eyes: a Prospective Study ______
    ORIGINAL ARTICLE Vol. 46 (2): 185-193, March - April, 2020 doi: 10.1590/S1677-5538.IBJU.2019.0094 Comparision effects of solifenacin, darifenacin, propiverine on ocular parameters in eyes: A prospective study _______________________________________________ Mahmut Taha Ölçücü 1, Kerem Teke 1, Kadir Yildirim 2, Mesut Toğaç 3, Burcu Işık 3, Yusuf Cem Yilmaz 3 1 Department of Urology, Agri State Hospital, Agri, Turkey; 2 Department of Urology, Elaziğ Education and Research Hospital, Elazig, Turkey; 3 Department of Ophthalmology, Agri State Hospital, Agri, Turkey ABSTRACT ARTICLE INFO Objective: To evaluate the effects of solifenacin, darifenacin, and propiverine on Mahmut Taha Ölçücü nasal-, subfoveal-, temporal choroidal thicknesses (NCT, SFCT, TCT), intraocular http://orcid.org/0000-0002-4721-2807 pressure (IOP) and pupil diameter (PD). Materials and Methods: Patients with overactive bladder (OAB) diagnosed accord- Keywords: ing to The International Continence Society were administered with solifenacin, Pressure; Urinary Bladder; darifenacin or propiverine on a daily basis between November 2017 and May 2018. Overactive; Anisocoria NCT, SFCT, TCT, IOP, and PD of these patients were measured and compared as Int Braz J Urol. 2020; 46: 185-93 initial, fourth and twelfth weeks. Results: A total of 165 patients (330 eyes) with OAB were evaluated. Solifenacin (n=140) signifi cantly reduced IOP from 17.30±2.72 mmHg to 16.67±2.56 mmHg _____________________ (p=0.006) and 16.57±2.41 mmHg (p=0.002), at the fourth and twelfth weeks, re- Submitted for publication: spectively. Darifenacin (n=110) signifi cantly reduced NCT from 258.70±23.96 μm February 08, 2019 to 257.51±22.66 μm (p=0.002) and 255.36±19.69 μm (p=0.038), at the fourth and _____________________ twelfth weeks, respectively.
    [Show full text]
  • Lääkealan Turvallisuus- Ja Kehittämiskeskuksen Päätös
    Lääkealan turvallisuus- ja kehittämiskeskuksen päätös N:o xxxx lääkeluettelosta Annettu Helsingissä xx päivänä maaliskuuta 2016 ————— Lääkealan turvallisuus- ja kehittämiskeskus on 10 päivänä huhtikuuta 1987 annetun lääke- lain (395/1987) 83 §:n nojalla päättänyt vahvistaa seuraavan lääkeluettelon: 1 § Lääkeaineet ovat valmisteessa suolamuodossa Luettelon tarkoitus teknisen käsiteltävyyden vuoksi. Lääkeaine ja sen suolamuoto ovat biologisesti samanarvoisia. Tämä päätös sisältää luettelon Suomessa lääk- Liitteen 1 A aineet ovat lääkeaineanalogeja ja keellisessä käytössä olevista aineista ja rohdoksis- prohormoneja. Kaikki liitteen 1 A aineet rinnaste- ta. Lääkeluettelo laaditaan ottaen huomioon lää- taan aina vaikutuksen perusteella ainoastaan lää- kelain 3 ja 5 §:n säännökset. kemääräyksellä toimitettaviin lääkkeisiin. Lääkkeellä tarkoitetaan valmistetta tai ainetta, jonka tarkoituksena on sisäisesti tai ulkoisesti 2 § käytettynä parantaa, lievittää tai ehkäistä sairautta Lääkkeitä ovat tai sen oireita ihmisessä tai eläimessä. Lääkkeeksi 1) tämän päätöksen liitteessä 1 luetellut aineet, katsotaan myös sisäisesti tai ulkoisesti käytettävä niiden suolat ja esterit; aine tai aineiden yhdistelmä, jota voidaan käyttää 2) rikoslain 44 luvun 16 §:n 1 momentissa tar- ihmisen tai eläimen elintoimintojen palauttami- koitetuista dopingaineista annetussa valtioneuvos- seksi, korjaamiseksi tai muuttamiseksi farmako- ton asetuksessa kulloinkin luetellut dopingaineet; logisen, immunologisen tai metabolisen vaikutuk- ja sen avulla taikka terveydentilan
    [Show full text]
  • Alphabetical Listing of ATC Drugs & Codes
    Alphabetical Listing of ATC drugs & codes. Introduction This file is an alphabetical listing of ATC codes as supplied to us in November 1999. It is supplied free as a service to those who care about good medicine use by mSupply support. To get an overview of the ATC system, use the “ATC categories.pdf” document also alvailable from www.msupply.org.nz Thanks to the WHO collaborating centre for Drug Statistics & Methodology, Norway, for supplying the raw data. I have intentionally supplied these files as PDFs so that they are not quite so easily manipulated and redistributed. I am told there is no copyright on the files, but it still seems polite to ask before using other people’s work, so please contact <[email protected]> for permission before asking us for text files. mSupply support also distributes mSupply software for inventory control, which has an inbuilt system for reporting on medicine usage using the ATC system You can download a full working version from www.msupply.org.nz Craig Drown, mSupply Support <[email protected]> April 2000 A (2-benzhydryloxyethyl)diethyl-methylammonium iodide A03AB16 0.3 g O 2-(4-chlorphenoxy)-ethanol D01AE06 4-dimethylaminophenol V03AB27 Abciximab B01AC13 25 mg P Absorbable gelatin sponge B02BC01 Acadesine C01EB13 Acamprosate V03AA03 2 g O Acarbose A10BF01 0.3 g O Acebutolol C07AB04 0.4 g O,P Acebutolol and thiazides C07BB04 Aceclidine S01EB08 Aceclidine, combinations S01EB58 Aceclofenac M01AB16 0.2 g O Acefylline piperazine R03DA09 Acemetacin M01AB11 Acenocoumarol B01AA07 5 mg O Acepromazine N05AA04
    [Show full text]
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued
    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
    [Show full text]
  • Factors Associated with Decisions for Initial Dosing, Up-Titration of Propiverine and Treatment Outcomes in Overactive Bladder S
    Journal of Clinical Medicine Article Factors Associated with Decisions for Initial Dosing, Up-Titration of Propiverine and Treatment Outcomes in Overactive Bladder Syndrome Patients in a Non-Interventional Setting Marjan Amiri 1,2 , Tim Schneider 3, Matthias Oelke 4, Sandra Murgas 5 and Martin C. Michel 6,* 1 Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, 45130 Essen, Germany; [email protected] 2 Center for Clinical Trials Essen (ZKSE), University Hospital Essen, 45130 Essen, Germany 3 Praxisklinik Urologie Rhein-Ruhr, 45468 Mülheim, Germany; [email protected] 4 Department of Urology, St. Antonius Hospital, 48599 Gronau, Germany; [email protected] 5 Apogepha, 01309 Dresden, Germany; [email protected] 6 Department of Pharmacology, Johannes Gutenberg University, 55131 Mainz, Germany * Correspondence: [email protected]; Tel.: +49-6131-179346 Abstract: Two doses of propiverine ER (30 and 45 mg/d) are available for the treatment of overactive bladder (OAB) syndrome. We have explored factors associated with the initial dosing choice (allo- cation bias), the decision to adapt dosing (escalation bias) and how dosing relative to other factors affects treatment outcomes. Data from two non-interventional studies of 1335 and 745 OAB patients, respectively, receiving treatment with propiverine, were analyzed post-hoc. Multivariate analysis was applied to identify factors associated with dosing decisions and treatment outcomes. Several Citation: Amiri, M.; Schneider, T.; parameters were associated with dose choice, escalation to higher dose or treatment outcomes, but Oelke, M.; Murgas, S.; Michel, M.C. only few exhibited a consistent association across both studies. These were younger age for initial Factors Associated with Decisions for dose choice and basal number of urgency and change in incontinence episodes for up-titration.
    [Show full text]